Aylestone Grange

Aylestone Grange is a small residential care home. Staff are registered to provide support to people with a mental health condition and/or substance misuse needs. At the time of the inspection, 9 people were living at the service but only 2 people received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Staff did not always have clear written guidance on how to support people. However, staff had received training and had good knowledge of people’s needs. Therefore, this poor documentation had not caused unsafe care.

Medicines were mostly managed safely. Some improvements were needed to the documentation of ‘as needed’ medicines. However, because staff had good knowledge of people’s medicine needs this did not impact people’s safety.

There were not always mental capacity assessments recorded for people. This lack of recording meant we were not assured that people’s ability to make decisions had been assessed. However, staff had good knowledge on how to support people to make decisions.

There were enough staff and these staff were safely recruited. Incidents were managed safely. People were kept safe from abuse. Professionals visited the service and staff had good knowledge of how these professionals supported people.

The care home was not always well managed. This is because concerns related to care planning, ‘as needed’ medicines and mental capacity assessments had not always been resolved in a timely way. Staff fed-back positively about the registered manager and advised they supported them well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 11 November 2020)

Why we inspected

The inspection was prompted due to an incident that had resulted in a serious injury to the person. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this specific concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement, based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aylestone Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach of regulation. This is in relation to the governance and oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aylestone Grange is a residential care home providing personal care and accommodation to up to 10 people with enduring mental health conditions. There were nine people using the service at the time of inspection. The service has ten en-suite bedrooms in one adapted building and a large communal living, dining and social area.

People’s experience of using this service and what we found

People had a range of risk assessments in their care files. One person who went out regularly into the community did not have a COVID-19 assessment for risks associated to this, although it was put in place immediately when brought to the attention of the registered manager.

The registered manager had changed since the last inspection. The current registered manager was well respected by the staff team. They had made positive changes to processes and quality assurance systems since taking on the role. The registered manager was aware of areas which still required improvements. For example, implementing effective care file audits to ensure files were up to date and accurate.

Medicine processes had improved since the last inspection. Staff were trained in medicine administration and their competence was checked. There were no medicine assessments setting out how people preferred to take their medicines, these were going to be put in place.

Recruitment processes had improved since the last inspection. During the COVID-19 pandemic the service avoided using agency workers. The staff team worked hard to cover any vacant shifts to achieve this.

Safeguarding processes were in place to ensure people were protected from the risk of abuse. Staff were aware of how to report any concerns by following safeguarding or whistleblowing procedures.

Staff and people living in the service regularly participated in tests for COVID-19. Enhanced cleaning schedules were in place and all rooms were cleaned daily. Social distancing measures were supported by the layout of the furniture in communal areas.

Staff had confidence any issues raised would be dealt with promptly. The registered manager promoted a positive and person-centred culture for everyone living in the service. The service worked in partnership with other health and social care professionals to ensure people's needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 November 2019). There were three breaches to regulations in the areas of governance arrangements, recruitment processes and medicines practices. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We had also received some concerns about the way the service was run which we wanted to examine further. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement, but we found improvements had been made and the provider was no longer in breach of regulations. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aylestone Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aylestone Grange is a residential care home providing personal care to 10 people at the time of the inspection. The service operates within an adapted building, can support up to 10 people, and specialises in supporting people to recover from enduring mental health conditions.

People’s experience of using this service and what we found

People’s prescribed medicines were not always managed safely. Medication records were not always accurate, and there had been occasions when people had run out of their prescribed medication. We found no evidence that people had been harmed, but systems were not robust enough to demonstrate that medicines were properly and safely managed.

People were supported by staff who had been recruited by the provider. However, the provider could not demonstrate that they had carried out all the necessary pre-employment checks; which meant there was a potential risk of unsuitable staff being employed.

People lived in a care home environment which was generally clean and safe. However, regular health and safety checks were not always carried out; and some people’s individual bedrooms and shower rooms were not clean. Support workers encouraged people to take part in keeping their own rooms clean, but it was recognised that people’s willingness to do that varied. Where potential environmental hazards had been identified, the provider had not always taken timely action to rectify things.

People were supported by enough support workers to meet their needs. Support workers had received the necessary training, and understood what action needed to be taken to safeguard people. People’s individual risk assessments had been regularly reviewed by the registered manager. That all helped ensure people were protected from avoidable risks.

People told us they felt safe living at Aylestone Grange. They had suitable person-centred care plans in place, which support workers had access to. That meant support workers were provided with the necessary information to effectively support people.

People were supported to eat and drink enough to maintain a balanced diet, and support workers advised people on healthy eating options where necessary. The care home was equipped to meet people’s basic needs and had an open plan lounge, dining and TV area. People could also freely access the patio and garden area. The decoration and furnishings could be made homelier, and the registered manager told us that was something they were working on.

People were supported to maintain contact with specialist mental health care teams and establish links with local community health care services. They were supported by staff who were attentive, and their cultural, equality and diversity needs were identified and supported.

People were involved in deciding their care plans, where they had the capacity to do so. Where they lacked the capacity, suitable best interest processes were in place. Care plans were comprehensive and covered areas such as their background, health care, personal care, nutritional needs and interests. People’s independence was encouraged and their privacy, and dignity, was maintained by the support workers. People were encouraged to attend resident meetings and to give their feedback to the registered manager on the service they received.

People chose to take part in activities that interested them, within the care home, or to access activities in the local community; with staff support if required. People were supported to maintain links with relatives, where that was appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aylestone Grange is a care home which provides support to up to 10 people with mental health conditions. At the time of our visit, 10 men with mental health conditions lived at the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had a good understanding of the Mental Capacity Act, however at least one person who lived in the home lacked capacity and was being deprived of their liberty. The registered manager had not applied for a Deprivation of Liberty Safeguard for these people before the inspection visit.

Staff and people understood safeguarding policies and procedures. Staff followed people’s individual risk assessments to ensure they minimised any identified risks to people’s health and social care needs. Checks were carried out prior to staff starting work at the service to reduce the risk of employing unsuitable staff.

People who lived at the home had complex mental health needs. There were enough staff on duty to keep people safe, and staff had received training to help them meet people’s needs effectively. People were supported to attend healthcare appointments for both physical and mental health needs as and when necessary.

People were encouraged by staff to improve their living skills and to move towards independent living where possible. Support was provided with cooking, cleaning, laundry and budgeting. People were provided with a choice of meals cooked by staff in the evening.

Staff were motivated to work with people who lived at Aylestone Grange. People and staff enjoyed good relationships with each other which were supportive, friendly, and caring. People and their relatives knew how to complain and both formal and informal complaints were investigated fully.

The registered manager was open and accessible to both people and staff. The provider was a regular visitor to the service and provided the manager with good support. There were sufficient informal and formal monitoring systems in place to ensure quality of service was maintained.